The nurse is educating a client about postpartum complications.
Which complication will be included for a primipara with a second-degree perineal laceration and repair?

Choice A rationale

Stronger contractions are not a specific complication of breech presentation. Contraction strength is related to uterine action and response to oxytocin, not solely to fetal presentation. Breech presentation primarily poses risks related to the birthing process itself, such as cord prolapse and birth trauma.

Choice B rationale

In a breech presentation, the presenting part (buttocks or feet) is less effective than the head in filling the pelvic inlet, potentially leaving space for the umbilical cord to prolapse, especially upon rupture of membranes. Cord prolapse causes nonreassuring fetal signs such as sudden, severe variable decelerations or prolonged bradycardia due to cord compression and subsequent fetal hypoxia.

Choice C rationale

Precipitate labor is characterized by very rapid cervical dilation and fetal descent, usually occurring within three hours of labor onset. This is not directly caused by a breech presentation. The mechanism of labor in breech is often slower and more complicated due to the less efficient presenting part.

Choice D rationale

Cessation of contractions often indicates uterine fatigue or uterine inertia, which can occur in prolonged labor or with specific uterine conditions, but it is not a direct or common complication of breech presentation. Overstretching of the uterus is typically associated with polyhydramnios or multiple gestation.

Choice A rationale

While the amount of blood loss is critical for determining the severity of the hemorrhage and the need for immediate treatment, it is not the priority assessment before administering methylergonovine. The amount of blood loss determines the need for the drug, but the blood pressure determines its safety before administration. Methylergonovine is a potent vasoconstrictor and must be used cautiously in clients with elevated blood pressure to prevent hypertensive crisis or stroke.

Choice B rationale

Methylergonovine is an ergot alkaloid that acts as a potent vasoconstrictor and uterine stimulant. Its primary side effect and contraindication are hypertension and preeclampsia. Because the drug dramatically increases systemic vascular resistance, it can cause a sudden, severe elevation in blood pressure. Therefore, checking the blood pressure is the priority assessment to ensure the client's pressure is within safe limits before administration, preventing potential complications like stroke.

Choice C rationale

Although a change in the level of consciousness (LOC) could indicate hypovolemic shock from severe blood loss or a hypertensive emergency, it is a secondary finding. The primary, direct, and modifiable risk associated with methylergonovine administration is its potential to cause acute, severe hypertension. Checking the client's baseline blood pressure (Choice B) is the specific, essential safety check before administering this vasoconstrictive medication.

Choice D rationale

The uterine tone or atony is the indication for the medication; the client is already diagnosed with uterine atony (flaccid uterus) causing the hemorrhage. The medication's purpose is to contract the uterus (increase tone). The priority before administration, however, is to assess the client for contraindications or serious adverse reaction risks. The potent vasoconstrictive effect on peripheral arteries makes blood pressure (Choice B) the most critical pre-administration safety assessment.